Provider Demographics
NPI:1629387626
Name:EDWARD V. POTTER, D.C., P.A.
Entity Type:Organization
Organization Name:EDWARD V. POTTER, D.C., P.A.
Other - Org Name:EDWARD POTTER, D.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-955-7788
Mailing Address - Street 1:3424 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-8906
Mailing Address - Country:US
Mailing Address - Phone:941-955-7788
Mailing Address - Fax:941-365-8611
Practice Address - Street 1:3424 17TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-8906
Practice Address - Country:US
Practice Address - Phone:941-955-7788
Practice Address - Fax:941-365-8611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-25
Last Update Date:2010-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0501352-00Medicaid
FL0501352-00Medicaid
FL88871Medicare PIN